I'm all for public money going to keeping you from dying, or developing a disease that prevents you from supporting yourself. Hell, some national single-payer for basic care would be nice. But pay for your elective cosmetic surgery out of your own damned wages like everyone else.

I'm in favor of LGBT rights as much as the next godless hippy librul, but using tax payer money to fund a non-life sustaining operation is not a good use of funds in my view. With the huge homeless problem in The City, how could anyone in good conscious be in favor of this?

I'm all for public money going to keeping you from dying, or developing a disease that prevents you from supporting yourself. Hell, some national single-payer for basic care would be nice. But pay for your elective cosmetic surgery out of your own damned wages like everyone else.

Not like this is the sole issue at stake, but do you then proceed to lament the stigma and lack of psychiatric care in the country after a mass shooting? Argue the cost-effectiveness of this over other things, but I think you'd need to be legitimately ignorant to say all elective cosmetic surgery is a matter of vanity and not a fundamental issue of emotional well-being for some people. Would you say the same about surgery for a cleft palate? I don't think there's any dispute that the surgery typically improves the internal disposition of a transgender identity, who you might guess aren't the most self-secure individuals if they're looking to radically alter their body to reinforce their identity. Nobody's doing it for kicks and giggles.

Again, that doesn't mean that financially this makes sense and you're obligated to support it, but "developing a disease that prevents you from supporting yourself" - it's inhuman to write off mental abnormality as being incapable of preventing someone from supporting themselves just because you're not experiencing the same issues, and it's why we have a problem with that area today. This is a case where those mental issues have a decent record of being improved or removed by a fixed surgical method. If a couple of snips would stop a vet from experiencing phantom limb syndrome, would you say that it isn't a real problem so it doesn't deserve to be fixed?

I'm all for public money going to keeping you from dying, or developing a disease that prevents you from supporting yourself. Hell, some national single-payer for basic care would be nice. But pay for your elective cosmetic surgery out of your own damned wages like everyone else.

It's not, however, "elective cosmetic surgery", but a necessary medical procedure, according to the AMA and DSM. If San Francisco is going to cover necessary medical procedures for uninsured residents, then it should cover all such necessary medical procedures, and not second-guess doctors. None of this "oh, sure, your doctor claims you need surgery, but I'm an elected public official with a law degree, so therefore I know more about medicine" bullshiat like you're suggesting.

Britney Spear's Speculum:I'm in favor of LGBT rights as much as the next godless hippy librul, but using tax payer money to fund a non-life sustaining operation is not a good use of funds in my view. With the huge homeless problem in The City, how could anyone in good conscious be in favor of this?

My thoughts too. Also add in California's and San Francisco's inability to pay it's bills.

I like how the article tries to say that the city pays for hysterectomies for breast cancer patients but not trans people and that's hypocritical. And the same for testicular cancer patients. What a farking joke. The nerve of some people, always thinking they're as important as cancer.

Britney Spear's Speculum:I'm in favor of LGBT rights as much as the next godless hippy librul, but using tax payer money to fund a non-life sustaining operation is not a good use of funds in my view. With the huge homeless problem in The City, how could anyone in good conscious be in favor of this?

Because by only being reactive to life threatening conditions, you're addressing them at their most expensive times, rather than spending a small amount of money earlier for preventative care. In this case, these operations may prevent severe depression, drug use, and suicide attempts, and obviate the need for expensive life-saving care and involuntary commitment to a psych ward.

My fat ass and giant ears give me body dysmorphia, so I am suicidal and a drug abuser. I'm just convinced in my heart that I truly am handsome. Please pay for my surgery. It's the only way I can feel comfortable as a human.

sage37:My fat ass and giant ears give me body dysmorphia, so I am suicidal and a drug abuser. I'm just convinced in my heart that I truly am handsome. Please pay for my surgery. It's the only way I can feel comfortable as a human.

Theaetetus:Britney Spear's Speculum: I'm in favor of LGBT rights as much as the next godless hippy librul, but using tax payer money to fund a non-life sustaining operation is not a good use of funds in my view. With the huge homeless problem in The City, how could anyone in good conscious be in favor of this?

Because by only being reactive to life threatening conditions, you're addressing them at their most expensive times, rather than spending a small amount of money earlier for preventative care. In this case, these operations may prevent severe depression, drug use, and suicide attempts, and obviate the need for expensive life-saving care and involuntary commitment to a psych ward.

With respect to the justice aspect of medical ethics, I don't see the expensive operation to prevent the possible circumstances you have listed as an ethical application of health care resources. I would change my opinion if there were research articles showing that this is a better use of resources.

evilmrsock: it's inhuman to write off mental abnormality as being incapable of preventing someone from supporting themselves just because you're not experiencing the same issues

How about I write it off as being incapable of preventing someone from supporting himself because it's incapable of preventing someone from supporting himself?

The only profession where thinking you're the wrong sex would prevent you from actually making a living is prostitution, and that's already illegal most places. Therefore, no, you don't get the same priority as people getting cancer, or losing limbs, or thinking they're Napoleon, etc. Not yours.

I'm not saying that the procedure should be illegal or anything, I'm saying if you want it save up and pay for it yourself.

LasersHurt:sage37: My fat ass and giant ears give me body dysmorphia, so I am suicidal and a drug abuser. I'm just convinced in my heart that I truly am handsome. Please pay for my surgery. It's the only way I can feel comfortable as a human.

This is not the same, and you know that. You are a bad person.

Why not? There are people that have a psychological need to change their appearance and suffer in their own skin. Whether it is a need to change gender or just a need to change your face or body to look a particular way if it is causing psychological damage why isn't it the same. What if someone was born with cleft lip or had a childhood disorder that left them with a minor deformity that caused them distress in their adult life? Are you trying to say they wouldn't deserve the same opportunity to fix it.

titwrench:LasersHurt: sage37: My fat ass and giant ears give me body dysmorphia, so I am suicidal and a drug abuser. I'm just convinced in my heart that I truly am handsome. Please pay for my surgery. It's the only way I can feel comfortable as a human.

This is not the same, and you know that. You are a bad person.

Why not? There are people that have a psychological need to change their appearance and suffer in their own skin. Whether it is a need to change gender or just a need to change your face or body to look a particular way if it is causing psychological damage why isn't it the same. What if someone was born with cleft lip or had a childhood disorder that left them with a minor deformity that caused them distress in their adult life? Are you trying to say they wouldn't deserve the same opportunity to fix it.

titwrench:LasersHurt: sage37: My fat ass and giant ears give me body dysmorphia, so I am suicidal and a drug abuser. I'm just convinced in my heart that I truly am handsome. Please pay for my surgery. It's the only way I can feel comfortable as a human.

This is not the same, and you know that. You are a bad person.

Why not? There are people that have a psychological need to change their appearance and suffer in their own skin. Whether it is a need to change gender or just a need to change your face or body to look a particular way if it is causing psychological damage why isn't it the same. What if someone was born with cleft lip or had a childhood disorder that left them with a minor deformity that caused them distress in their adult life? Are you trying to say they wouldn't deserve the same opportunity to fix it.

I am saying that his "I don't feel handsome enough plz halp" comment was ridiculous. This is not a comment on the actual merits of psychological issues related to appearance, particularly with "real" problems like a cleft pallet or club foot.

There may be an argument to be had about sexual identity or actual deformities - not his "handsomeness" idiocy.

LasersHurt:sage37: My fat ass and giant ears give me body dysmorphia, so I am suicidal and a drug abuser. I'm just convinced in my heart that I truly am handsome. Please pay for my surgery. It's the only way I can feel comfortable as a human.

This is not the same, and you know that. You are a bad person.

If it's not the same, prove that it isn't. You're asserting that a person who believes they need gender reassignment surgery is different than someone who wants a nose job, chin implants etc.

Britney Spear's Speculum:Theaetetus: Britney Spear's Speculum: I'm in favor of LGBT rights as much as the next godless hippy librul, but using tax payer money to fund a non-life sustaining operation is not a good use of funds in my view. With the huge homeless problem in The City, how could anyone in good conscious be in favor of this?

Because by only being reactive to life threatening conditions, you're addressing them at their most expensive times, rather than spending a small amount of money earlier for preventative care. In this case, these operations may prevent severe depression, drug use, and suicide attempts, and obviate the need for expensive life-saving care and involuntary commitment to a psych ward.

With respect to the justice aspect of medical ethics, I don't see the expensive operation to prevent the possible circumstances you have listed as an ethical application of health care resources. I would change my opinion if there were research articles showing that this is a better use of resources.

Not sure I understand what you were saying - first "justice" aspect of medical ethics? Second, why is it not ethical to prevent suicide?Or, are you saying that "we could help one person for $X with this operation, or we could help 10 homeless people for the same $X, and therefore it is more just that we spend the money on the 10 people"?

Britney Spear's Speculum:LasersHurt: sage37: My fat ass and giant ears give me body dysmorphia, so I am suicidal and a drug abuser. I'm just convinced in my heart that I truly am handsome. Please pay for my surgery. It's the only way I can feel comfortable as a human.

This is not the same, and you know that. You are a bad person.

If it's not the same, prove that it isn't. You're asserting that a person who believes they need gender reassignment surgery is different than someone who wants a nose job, chin implants etc.

Are you asserting the contrary? That a person who believes they need gender reassignment surgery is no different than someone who wants a nose job, chin implants, etc.?

LasersHurt:titwrench: LasersHurt: sage37: My fat ass and giant ears give me body dysmorphia, so I am suicidal and a drug abuser. I'm just convinced in my heart that I truly am handsome. Please pay for my surgery. It's the only way I can feel comfortable as a human.

This is not the same, and you know that. You are a bad person.

Why not? There are people that have a psychological need to change their appearance and suffer in their own skin. Whether it is a need to change gender or just a need to change your face or body to look a particular way if it is causing psychological damage why isn't it the same. What if someone was born with cleft lip or had a childhood disorder that left them with a minor deformity that caused them distress in their adult life? Are you trying to say they wouldn't deserve the same opportunity to fix it.

I am saying that his "I don't feel handsome enough plz halp" comment was ridiculous. This is not a comment on the actual merits of psychological issues related to appearance, particularly with "real" problems like a cleft pallet or club foot.

There may be an argument to be had about sexual identity or actual deformities - not his "handsomeness" idiocy.

Why not? Society rewards attractiveness. if being homely causes problems for a person psychologically how is there perception of themselves being uncomfortable in their body any less important than someone that feels they need to change their gender? The emotional and mental need is the same.

titwrench:LasersHurt: titwrench: LasersHurt: sage37: My fat ass and giant ears give me body dysmorphia, so I am suicidal and a drug abuser. I'm just convinced in my heart that I truly am handsome. Please pay for my surgery. It's the only way I can feel comfortable as a human.

This is not the same, and you know that. You are a bad person.

Why not? There are people that have a psychological need to change their appearance and suffer in their own skin. Whether it is a need to change gender or just a need to change your face or body to look a particular way if it is causing psychological damage why isn't it the same. What if someone was born with cleft lip or had a childhood disorder that left them with a minor deformity that caused them distress in their adult life? Are you trying to say they wouldn't deserve the same opportunity to fix it.

I am saying that his "I don't feel handsome enough plz halp" comment was ridiculous. This is not a comment on the actual merits of psychological issues related to appearance, particularly with "real" problems like a cleft pallet or club foot.

There may be an argument to be had about sexual identity or actual deformities - not his "handsomeness" idiocy.

Why not? Society rewards attractiveness. if being homely causes problems for a person psychologically how is there perception of themselves being uncomfortable in their body any less important than someone that feels they need to change their gender? The emotional and mental need is the same.

Sure, and it is the same... His self-reporting isn't enough, of course, but if a qualified doctor or two find that yes, he is suicidal, and the only thing that would keep him from killing himself is a nose job, then isn't a nose job a medically necessary procedure?

My thoughts too. Also add in California's and San Francisco's inability to pay it's bills.

I would like to point out that CA is on track to have a Surplus and SF has never had an 'inability to pay it's bills,' even through the worst of CA's fiscal issues. Hey how about all the states rights' and spending decisions need to be made locally folks stand up for something like this in principle even if you don't agree with the premise?

titwrench:LasersHurt: titwrench: LasersHurt: sage37: My fat ass and giant ears give me body dysmorphia, so I am suicidal and a drug abuser. I'm just convinced in my heart that I truly am handsome. Please pay for my surgery. It's the only way I can feel comfortable as a human.

This is not the same, and you know that. You are a bad person.

Why not? There are people that have a psychological need to change their appearance and suffer in their own skin. Whether it is a need to change gender or just a need to change your face or body to look a particular way if it is causing psychological damage why isn't it the same. What if someone was born with cleft lip or had a childhood disorder that left them with a minor deformity that caused them distress in their adult life? Are you trying to say they wouldn't deserve the same opportunity to fix it.

I am saying that his "I don't feel handsome enough plz halp" comment was ridiculous. This is not a comment on the actual merits of psychological issues related to appearance, particularly with "real" problems like a cleft pallet or club foot.

There may be an argument to be had about sexual identity or actual deformities - not his "handsomeness" idiocy.

Why not? Society rewards attractiveness. if being homely causes problems for a person psychologically how is there perception of themselves being uncomfortable in their body any less important than someone that feels they need to change their gender? The emotional and mental need is the same.

No, it's not the same. The pressures felt by someone who is "the wrong gender" is NOT AT ALL the same as the pressures one feels to be attractive. The two are not equal.

titwrench:LasersHurt: sage37: My fat ass and giant ears give me body dysmorphia, so I am suicidal and a drug abuser. I'm just convinced in my heart that I truly am handsome. Please pay for my surgery. It's the only way I can feel comfortable as a human.

This is not the same, and you know that. You are a bad person.

Why not? There are people that have a psychological need to change their appearance and suffer in their own skin. Whether it is a need to change gender or just a need to change your face or body to look a particular way if it is causing psychological damage why isn't it the same. What if someone was born with cleft lip or had a childhood disorder that left them with a minor deformity that caused them distress in their adult life? Are you trying to say they wouldn't deserve the same opportunity to fix it.

You surely must realize how ridiculous it is to reduce both to "feeling uncomfortable" and saying they're the same? That's like saying a papercut and a knifewound are the same. Sure, both cuts, but treated differently because they are of different severity.

LasersHurt:titwrench: LasersHurt: titwrench: LasersHurt: sage37: My fat ass and giant ears give me body dysmorphia, so I am suicidal and a drug abuser. I'm just convinced in my heart that I truly am handsome. Please pay for my surgery. It's the only way I can feel comfortable as a human.

This is not the same, and you know that. You are a bad person.

Why not? There are people that have a psychological need to change their appearance and suffer in their own skin. Whether it is a need to change gender or just a need to change your face or body to look a particular way if it is causing psychological damage why isn't it the same. What if someone was born with cleft lip or had a childhood disorder that left them with a minor deformity that caused them distress in their adult life? Are you trying to say they wouldn't deserve the same opportunity to fix it.

I am saying that his "I don't feel handsome enough plz halp" comment was ridiculous. This is not a comment on the actual merits of psychological issues related to appearance, particularly with "real" problems like a cleft pallet or club foot.

There may be an argument to be had about sexual identity or actual deformities - not his "handsomeness" idiocy.

Why not? Society rewards attractiveness. if being homely causes problems for a person psychologically how is there perception of themselves being uncomfortable in their body any less important than someone that feels they need to change their gender? The emotional and mental need is the same.

No, it's not the same. The pressures felt by someone who is "the wrong gender" is NOT AT ALL the same as the pressures one feels to be attractive. The two are not equal.

Tell that to girls suffering anorexia and bulimia. Their need to "fix" themselves is just as damaging psychologically as someone that feels the need to change gender. To person suffering the need is no less important as anyone else's. Just because you perceive a nose job as trivial compared to gender reassignment, to the person that is crippled by their feeling that their appearance is not who they are it isn't .

I think part of the problem is that there is a misunderstanding about the preconditions to get this surgery. It's not like plastic surgery where you go make an appointment with a doc and have an outpatient procedure or something along those lines. From my understanding you need a psych evaluation and you need to live like your target gender for a period of time. You also just cannot fly into SF claim residency and wait on your castration line... It's not like penises and vaginas are being given out like Halloween presents in the Castro....

titwrench:Tell that to girls suffering anorexia and bulimia. Their need to "fix" themselves is just as damaging psychologically as someone that feels the need to change gender. To person suffering the need is no less important as anyone else's. Just because you perceive a nose job as trivial compared to gender reassignment, to the person that is crippled by their feeling that their appearance is not who they are it isn't .

I will agree with you when you can point me to the numerous stories of people trying to give themselves a nose job at home...

Theaetetus:titwrench: Just because you perceive a nose job as trivial compared to gender reassignment, to the person that is crippled by their feeling that their appearance is not who they are it isn't .

I think the issue here was that Lasers reasonably believes that Sage was trolling.

Bingo. I do not believe he was speaking on behalf of those with serious mental issues, I think he was trying to be a dick.

Please realize I am not arguing vanity or a stripper that gets a set of bolt ons to increase her tips. I am arguing that there are people that suffer due to body dismorphia on many levels and in different ways and if we are going to say it is OK to pay for one it had to be OK for them all. You can't just walk in and say I want to be a woman and the state writes a check. You have to go through a long process of physical and psychological evaluation and the process should be the same for all cases but you can't tell one person that suffers yes and the other one no because of some perceived difference in importance.

titwrench:LasersHurt: titwrench: Tell that to girls suffering anorexia and bulimia.

Look at those goalposts move!

"All things are equal, or none are."

How did I move the goal posts? I presented a perfectly reasonable example of how people are psychologically tortured by their need to look different.

Because you're lumping together entirely dissimilar things under the banner of "tortured by their need to look different." The issues are far more complex than that.

Regardless, we're still off topic - I responded to another, DIFFERENT person's post because I felt they were being intentionally disingenuous. You wanted to take me up on that for some reason, but that's not why I am here.

How did I move the goal posts? I presented a perfectly reasonable example of how people are psychologically tortured by their need to look different.

Because you're lumping together entirely dissimilar things under the banner of "tortured by their need to look different." The issues are far more complex than that.

Regardless, we're still off topic - I responded to another, DIFFERENT person's post because I felt they were being intentionally disingenuous. You wanted to take me up on that for some reason, but that's not why I am here.

That's what I thought until I did the research - they self mutilated and suicide. The self mutilation part goes back hundreds of years. I mean when a dude cuts off his talleywacker, someone will write a story about it.

How did I move the goal posts? I presented a perfectly reasonable example of how people are psychologically tortured by their need to look different.

Because you're lumping together entirely dissimilar things under the banner of "tortured by their need to look different." The issues are far more complex than that.

Regardless, we're still off topic - I responded to another, DIFFERENT person's post because I felt they were being intentionally disingenuous. You wanted to take me up on that for some reason, but that's not why I am here.

Wasilla Hillbilly:Theaetetus: Wasilla Hillbilly: evilmrsock: I don't think there's any dispute that the surgery typically improves the internal disposition of a transgender identity

Citation needed

Citation of a lack of dispute in the medical community? Citation of a lack of something? Really?How about you find a citation that there is a serious dispute in the medical* community, mmkay?

*note, "medical". Not "political" or "religious".

Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity [diseased state] than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism